title: Bimanual technique for insertion and positioning of endothelium-Descemet membrane graft in Descemet membrane endothelial keratoplasty.
abstract: OBJECTIVE
  To describe a new bimanual technique for insertion and positioning of endothelium-Descemet membrane (EDM) grafts in Descemet membrane endothelial keratoplasty (DMEK).
  
  
  METHODS
  Prospective, noncomparative, consecutive interventional case series, including 15 pseudophakic eyes of 15 patients treated with DMEK at the Instituto de Microcirugia Ocular, Barcelona, Spain. A bimanual infusion technique was used to introduce and position donor's EDM. Partial tamponade was achieved with 20% sulfur hexafluoride (SF6). Intraocular manipulation time of EDM grafts, rebubbling rate, and endothelial cell density were evaluated.
  
  
  RESULTS
  Six months postoperatively, mean uncorrected visual acuity and best spectacle-corrected visual acuity (BSCVA) improved from 20/100 to 20/50 and from 20/80 to 20/25, respectively (P < 0.001). Six eyes (40%) had ≥ 20/20 BSCVA, and 13 (86%) eyes had ≥ 20/30 BSCVA. Mean donor cell density decreased from 2690 ± 302 to 1998 ± 621 cells per square millimeter, representing a mean cell loss of 26% ± 20%. EDM was stripped successfully in all cases. Mean intraocular manipulation time of donor's EDM (interval between main incision closure and final EDM positioning) was 4.10 ± 0.5 minutes. Intracameral air reinjection was needed in 1 case (6.6%) with a partial peripheral graft detachment. No episodes of immunologic graft rejection were documented.
  
  
  CONCLUSIONS
  Insertion and positioning of EDM grafts in DMEK was successfully achieved using this bimanual infusion technique and 20% SF6 partial tamponade, with a low intraocular manipulation time and very low postoperative rebubbling rates, regardless of the preservation method and the donor's age. However, prospective comparative studies are required to demonstrate the long-term safety compared with other approaches.
authors.affiliation: *The Cornea and Refractive Surgery Unit and †Cornea and Refractive Surgery Unit, Instituto de Microcirugia Ocular, Barcelona, Spain; ‡Department of Ophthalmology, Universitat Autonoma de Barcelona, Barcelona, Spain; Departments of §Cornea and Anterior Segment Diseases and ¶Refractive Surgery, Institut Clinic d'Oftalmologia, Hospital Clinic i Provincial, Barcelona, Spain.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Güell
authors.forename: Merce
authors.initials: M
authors.lastname: Morral
authors.forename: Oscar
authors.initials: O
authors.lastname: Gris
authors.forename: Daniel
authors.initials: D
authors.lastname: Elies
authors.forename: Felicidad
authors.initials: F
authors.lastname: Manero
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014792:Visual Acuity / Q000502:physiology